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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
40 44634 ARICEPT 5MG TAB (PFI/STO) DONEPEZIL DONEPEZIL ARICEPT 28'S C 131.89 4.71 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 44634 ARICEPT 5MG TAB (PFI) DONEPEZIL (C) DONEPEZIL ARICEPT 28'S C 117.38 4.192 TAB 30 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 30.09 1.07 TABLET 0 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2022-06-16 Oral 0 AUTONOMIC DRUGS
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q 28'S A 30.09 1.07 TABLET 30 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-06-17 2022-09-30 Oral 6 AUTONOMIC DRUGS 2022-06-17
41 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL (C) DONEPEZIL YASNAL Q 28'S C 30.09 1.0747 TAB 30 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS
40 4463N DONEPEZIL 5MG TAB (CIP/AHI) DONEPEZIL DONEPEZIL 4X7'S A 8.05 0.2875 TABLET IMMED 30 CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-11-29 2024-03-31 Add to Contract as Cat A oral 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-11-29
40 44642 ARICEPT 10MG TAB (PFI/STO) DONEPEZIL DONEPEZIL ARICEPT 28'S C 144.45 5.16 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 44642 ARICEPT 10MG TAB (PFI) DONEPEZIL (C) DONEPEZIL ARICEPT 28'S C 128.55 4.5911 TAB 30 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4464A APO-DONEPEZIL 10MG TAB (APO/COL) DONEPEZIL DONEPEZIL APO-DONEPEZIL 100'S A 95.14 0.95 TABLET 30 TAB APO APOTEX INC. COL COLLINS LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 6 AUTONOMIC DRUGS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S C 47.57 1.70 TABLET 0 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 Oral 0 AUTONOMIC DRUGS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S A 47.57 1.70 TABLET 30 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-06-17 2022-09-30 Oral 6 AUTONOMIC DRUGS 2022-06-17
41 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL (C) DONEPEZIL YASNAL Q 28'S C 47.57 1.699 TABDISP 0 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
41 4464P PMS-DONEPEZIL 10MG TAB (PMS) DONEPEZIL PMS-DONEPEZIL 100'S A 53.01 0.5301 TAB 30 BOTT PMS PHARMASCIENCE COL COLLINS LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS